Cerebral Cortical Examination

Vernon M Neppe MD, PhD,FRCPC, FFPsych, MMed

BRIEF INTRODUCTION TO THE BEHAVIORAL NEUROLOGICAL EXAMINATION

The neuropsychiatric mental status or behavioral neurological examination interfaces between psychiatry and neurology. Behavioral neurological examination consists specifically of the following evaluations of:

Consciousness
Orientation for time, place, and space
Evaluation of speech, i.e. dysphasia, dysarthria, dysphonia
Evaluation of praxis
Evaluation of gnosis, i.e. recognition, interpretation and organization of percepts - agnosias
Evaluations of memory
Intelligence - verbal
Calculation
Melodic functions
Frontal-temporal functioning

Assessment of the neuropsychiatric mental status of the patient is vital in any patient who may exhibit features of possible coarse neurobehavioral disease. One rapid but very inadequate method has involved the 30 point Folstein Mini-Mental Status Examination (neither specific, nor sensitive). A very promising instrument is the BROCAS SCAN (Screening Cerebral Assessment of Neppe). This takes 15-30 minutes and involves 40 items. The B of the term BROCAS refers to behavior, and all facets of the Mental Status Examination are compared with the behavioral component. The ROCAS items are made up of two each of R-O-C-A-S: recall, recognition, orientation, organization, concentration, calculation, apraxia, agnosia, speech and sensory motor reflex. A Clinical BROCAS SCAN exists. Organic mental disorders are a heterogeneous group,of conditions which reflect differences in localization, mode of onset, progression, duration and nature of underlying pathophysiological processes. Organic mental disorders may occur at any age, but many are more prevalent in the population over 60 years of age. Patients with these conditions are particularly relevant for the BROCAS SCAN.

Patients with these conditions are particularly relevant for the BROCAS SCAN